Adult Family Living (AFL) in Connecticut: A Home Care Option for Families
Key Takeaways
- AFL lets an eligible family member live with a loved one and get paid to give care.
- Connecticut offers AFL two ways: CHCPE, for adults 65 and older, and the PCA Waiver, for adults 18 to 64 with a qualifying disability.
- A spouse generally cannot be the paid caregiver. Other relatives may qualify.
- The caregiver and the person getting care must live in the same home.
- Pay is based on a care level DSS assigns, not a fixed rate. Ask Cottage for the current range in writing.
- AFL is not free for everyone. Some people owe applied income, and some pay a 3% cost share.
- Some AFL payments may skip federal income tax under IRS Notice 2014-7, but not every tax.
- Cottage Home Care guides you from your first call to the last step, based on your family's needs, and helps you work through problems as they come up.
Adult Family Living (AFL) is one of the core home care options available in Connecticut through Medicaid. It allows an eligible family member to provide care for a loved one at home and be compensated for the care they provide, as long as they are living together. In general, a spouse cannot serve as the paid caregiver under this arrangement.
Table of Contents
What Is Adult Family Living?
AFL helps an adult get care while living in a real home, not a facility. The person may need help because of a disability, older age, or another health issue.
A caregiver who lives with them can help with:
- Personal care
- Bathing and grooming
- Dressing
- Cooking meals
- Eating
- Getting around the home
- Other household jobs
The exact help depends on the person's care plan. A care plan is the list of services the state has approved for that person.
The caregiver and the person who needs care must live in the same home. Some families already live together. In other cases, one person moves in with the other.
An AFL agency oversees the setup. Cottage can act as this agency. The AFL agency trains the caregiver, checks on the home, and helps with paperwork for the state. This is not the same as skilled nursing care. A home health aide gives hands-on daily help, not medical care. If the person needs a nurse, for example for wound care or medication help, that care is set up on its own.
Can a Family Member Get Paid?
Yes. A family member can get paid to give approved care through AFL, if both the caregiver and the person needing care meet the program's rules.
Here's an example. A daughter already helps her mother get dressed, cooks her meals, helps her bathe, and helps her move around the home. She has done this without pay. If her mother meets the program's rules, the daughter may become an approved, paid caregiver.
The same kind of setup may work for other relatives, such as a son, sibling, or other close family member, depending on the case.
What About a Spouse?
In general, a spouse cannot be the paid caregiver under AFL. Other relatives may qualify instead, depending on the rules and the family's case. Check who qualifies early instead of guessing who can be paid.
If the person has a legal guardian or conservator, that role must be checked under CHCPE or PCA Waiver rules. This can affect who may be the paid caregiver.
Before an arrangement can start, the caregiver usually needs to:
- Be a relative other than a spouse
- Live full-time in the same home as the person getting care
- Be able to safely meet that person's daily needs
- Complete training and a background check through the AFL agency
Why Are Connecticut Families Interested in AFL?
Many families are already giving daily care. A daughter may care for her mother. A son may help his father. A sibling may help a brother or sister with meals, personal care, or getting around the house.
AFL lets these families keep the loved one at home while getting paid and supported for care they already give. The AFL agency gives training, regular check-ins, and a contact person for questions or changing needs.
Who Can Apply for AFL?
AFL is not one program with one set of rules. Connecticut offers AFL through two Medicaid programs. Which one applies depends on the person's age.
The Connecticut Home Care Program for Elders (CHCPE) serves adults 65 and older who are at risk of needing nursing home care.
The Personal Care Assistance (PCA) Waiver serves adults 18 to 64 with a serious, long-term disability. To qualify, a person must need hands-on help with at least two daily tasks, lack enough family or community support, and be able to direct their own care, or have a conservator do it for them.
Factors that may be considered for either program include:
- Medicaid eligibility
- Age (65 or older)
- Disability or care needs
- Assistance needed with daily activities
- Level of care required
- Financial eligibility (under $2,901.00 per month)
- Ability to safely receive care at home
- Other program requirements
The bullet above reflects the older guidance Cottage has used. Connecticut's 2026 CHCPE limit is $2,982 in monthly income and $1,600 in countable assets for one person. Countable assets are the assets the program counts toward this limit; a primary home is often not counted. These numbers apply to the person getting care, not to caregiver pay. They also do not apply to the PCA Waiver, which uses its own Medicaid rules.
Being a family member does not always mean you will be approved. Both the person getting care and the caregiver must meet all program rules. Having HUSKY Health coverage or a low income does not, by itself, mean approval.
CHCPE
Who it serves: Adults 65 and older
Main requirement: At risk of needing nursing home care
Who directs care: A case manager helps arrange it
Run by: CT Department of Social Services
PCA Waiver
Who it serves: Adults 18 to 64 with a qualifying disability
Main requirement: Hands-on help with 2+ daily tasks, and not enough other support
Who directs care: The person directs their own care, or a conservator does
Run by: CT Department of Social Services
What Does Adult Family Living Cost in Connecticut?
What a family pays depends on the program used and the person's own income and assets.
The person getting care. People in the Medicaid-funded CHCPE path must pay any monthly income above $2,660 toward their care. This is called applied income. People in the state-funded CHCPE path pay 3% of their monthly cost of care, plus the same applied income above $2,660. Some costs, like a medical insurance bill, can lower what's owed. If your income or assets are close to a limit, ask Cottage or a benefits helper to review your case. The rules here are detailed.
The caregiver's pay. DSS sorts each person getting care into a care level, based on their needs. This level sets how much the caregiver is paid. Cottage can share more about current pay once a care level is set.
The agency's pay. The state pays the AFL agency on its own, for training, oversight, and paperwork. That amount is not the same as what the caregiver is paid.
Household bills. The caregiver's pay covers caregiving. It does not cover rent, mortgage, utility bills, or groceries. Those stay the family's job, as in any home.
Taxes. Some AFL payments can be left out of federal income tax under IRS Notice 2014-7. This rule covers certain Medicaid payments to a caregiver who lives with the person they care for. It does not mean every payment skips every tax. Talk with a tax expert about your own case.
How Do You Get Started?
Contact Cottage Home Care. We will help you through each step, including any Medicaid application.
Before you call, have these ready:
- Proof of Connecticut residency
- Proof of the applicant's age or disability
- Recent income and asset records
- Proof of address for the shared home, like a lease, mortgage statement, or utility bill
Here's how the process usually works:
- Referral. You contact Cottage or the state to start. For CHCPE, this is often done with form W-1487. A referral is not the same as an approved Medicaid application.
- Assessment. The state checks if the applicant meets the CHCPE or PCA Waiver rules.
- Medicaid application, if needed. If the applicant isn't already enrolled in the right Medicaid category, DSS reviews income and assets as part of the application.
- Care plan approval. Once approved, DSS and a case manager approve a care plan and care level. This sets the caregiver's pay level.
- Caregiver and home checks. The AFL agency does caregiver training, a background check, and a home visit.
- Confirmed start of service. Care begins once DSS approves a start date.
The state controls the timeline, so no agency can promise an exact approval date. What Cottage can promise is this: we push your paperwork forward quickly on our end, stay on top of every step, and follow up so your case never sits waiting longer than it has to.
Already Caring for Your Loved One?
If you already care for your mother, father, sibling, or another loved one every day, you may want to learn about getting paid for that care.
You may be asking:
"Can my daughter get paid to take care of me?"
"Can my son become my paid caregiver?"
"Can I get home care through Medicaid?"
"Could AFL work for my family?"
Cottage can help you find that answer. We'll walk through your loved one's situation against Connecticut's rules and show you which options give your family the most benefit.
Don't Wait to Learn About Your Options
If your loved one needs ongoing help at home, Adult Family Living may be an option worth exploring. Your family member may already be giving valuable care every day. If the person qualifies and the caregiver meets the rules, AFL can pay that family caregiver for the care they give.
Talk with Cottage's Connecticut team about your family's needs and your next steps:
cottagehomecare.com/connecticut/contact
How Much Can a Family Member Caregiver Earn?
There is no single dollar amount for every AFL caregiver. DSS places each person getting care into a care level, based on an assessment, and that level sets the pay range. Cottage pays your caregiver directly, using funds from DSS, so your family isn't managing separate billing. Cottage also works to make sure the assessment fully reflects your loved one's needs, so your caregiver is paid at the strongest rate the approved care level allows. Ask Cottage about current pay ranges once an assessment is set up.
Before the setup starts, ask for these answers in writing:
- What care level was approved, and what does that level pay?
- How and how often will payment be made?
- What has to happen before the first payment, and when is it expected?
- How do absences, hospital stays, or breaks in care affect pay?
Some AFL payments can be left out of federal income tax under IRS Notice 2014-7. Ask a tax expert how this applies to your case.
Frequently Asked Questions
Do the caregiver and the person needing care have to live together?
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Yes. AFL requires the caregiver and the person getting care to live in the same home full-time.
Can we apply before Medicaid is active?
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You can start the referral and assessment steps first. The AFL setup itself starts once the person is confirmed eligible for CHCPE or the PCA Waiver.
Can someone under 65 qualify?
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Yes. Adults 18 to 64 with a qualifying disability may get AFL through the PCA Waiver instead of CHCPE.
Does Medicare pay for this instead of Medicaid?
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Medicare usually does not cover ongoing personal care, like help with bathing or dressing, when that is the only care someone needs. Medicare may cover part-time or short skilled home care, like nursing or therapy, when a doctor orders it and certain rules are met. AFL pay is a Medicaid benefit, separate from Medicare.
Can the caregiver also work outside the home?
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This depends on the care plan and how much watching over the person needs. Talk with Cottage before you plan on outside work.
What happens during a hospital stay or a planned break?
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How a hospital stay or break affects pay depends on the care plan. Ask Cottage to confirm this in writing before the setup starts.
Sabine DurgaramDPS/RN
